Scott T Reeves1, Jeana E Havidich, D Patrick Tobin. 1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. reevess@musc.edu
Abstract
OBJECTIVE: To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer. METHODS: Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures. RESULTS: The mean BIS score was 62.8+/- 9.6. The mean low BIS score was 29.7 +/- 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure. The average dose of propofol was 166 +/- 47 microg/kg/min. Mean Aldrete score for level of consciousness was 0.9 +/- 0.4, indicating a depressed level of consciousness. The mean activity level was 1.0+/- 0.4, indicating impaired movement. CONCLUSIONS: Children who undergo conscious sedation with propofol for intrathecal chemotherapy and bone marrow aspiration demonstrate BIS values and clinical assessments consistent with deep sedation. Because of an increased risk of adverse events when children undergo deep sedation, appropriate parental informed consent, age-appropriate resuscitative equipment, and skilled anesthesia personnel should be present for rescue in the event of cardiovascular and respiratory complications from deep sedation.
OBJECTIVE: To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer. METHODS: Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures. RESULTS: The mean BIS score was 62.8+/- 9.6. The mean low BIS score was 29.7 +/- 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure. The average dose of propofol was 166 +/- 47 microg/kg/min. Mean Aldrete score for level of consciousness was 0.9 +/- 0.4, indicating a depressed level of consciousness. The mean activity level was 1.0+/- 0.4, indicating impaired movement. CONCLUSIONS:Children who undergo conscious sedation with propofol for intrathecal chemotherapy and bone marrow aspiration demonstrate BIS values and clinical assessments consistent with deep sedation. Because of an increased risk of adverse events when children undergo deep sedation, appropriate parental informed consent, age-appropriate resuscitative equipment, and skilled anesthesia personnel should be present for rescue in the event of cardiovascular and respiratory complications from deep sedation.